Substitution urethroplasty: Buccal mucosal graft Vs local flaps - A prospective randomized study
Journal Title: International Archives of Integrated Medicine - Year 2016, Vol 3, Issue 10
Abstract
Introduction: Urethral stricture is a common condition with varying etiology and management, determined by cause, site and length of stricture. Materials and methods: We presented here a randomized prospective trial comparing dorsal onlay buccal mucosa graft and penile skin flap urethroplasty at our institute over 3 years period. Results: Total 22 patients underwent substitution urethroplasty during this period. The mean age and follow up was 31.31 years and 9 months respectively. The most common cause of stricture urethra was post inflammatory (40.90%) followed by traumatic (36.36%) and balanitis xerotica obliterence (22.72%). Majority had combined penobulbar stricture (45.45%), followed by penile (31.81%) and bulbar (22.7%). The average size of the urethral stricture was 6.81 cm. The most common symptom of presentation of stricture urethra was thin stream (100%) followed by dysuria (80%), frequency (71.42%) and dribbling (30%). Most of the patients underwent surgical procedure prior to presentation; urethral dilatation done in 13 (59.05%) patients followed by visual internal urethrotomy 7 (31.81%) patients and suprapubic cystostomy in 4 (18.18%) patients. Of 22 patients, 10 (45.45%) underwent local flap and 12 (54.54%) patients buccal mucosal graft. Out of 10 local flap technique, 8 (36.36%) patients underwent ventral longitudinal flap and 2 (9.09%) underwent Quartey flap. Out of 12 buccal mucosal graft technique, 5 (22.72%) patients underwent ventral onlay graft, 5 (22.72%) dorsal onlay and 2 (9.09%) tube circumferential graft. Total success rate was 72.72%. Success rate was higher with buccal mucosal graft (83.33%) compared to local flap technique (60%). Among local flap technique, ventral longitudinal flap (62.5%) had better results than quartey flap (50%). Among buccal mucosal graft dorsal onlay graft had best (100%) results followed by ventral onlay (80%) and then tube circumferencial graft (50%). Patients with smaller stricture length (2.5-7.5 cm) had better (75%) results. Patients with combined penobulbar (90%) and BXO as etiology (80%) also had better results. Conclusion: The success rate of buccal mucosal free graft substitution urethroplasty is better than local penile skin flaps in patients with anterior urethral strictures.
Authors and Affiliations
G. Mallikarjuna, N. Ramamurthy, Ravi Jahagirdar, Dr. Jagadeeshwar
Keywords
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